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Patient Care

The Patient-Provider Experience: Informed Dissent

Have you ever been a patient in an ambulance, before or after becoming an EMS provider? Have you witnessed a loved one become a patient? How did it alter your perception of patient care? EMS World’s newest series, “The Patient-Provider Experience,” shares the stories of both patients and providers who have been impacted by their respective experiences with EMS—on or off the cot—and how these experiences changed the way they provide care.


I have a case I’d like to discuss with you. Except for a few members of the patient’s family, the patient’s surgeon, the surgeon’s receptionist, several nurses, and an attorney who specializes in calming me down, you’re the first to hear about it.


A 57-year-old female—we’ll call her Helen Rubin—had complained of intermittent, severe, lower abdominal pain for several weeks. She was diagnosed with perforation of a very important organ—less important than her stomach, more important than her gall bladder—and was admitted to a hospital in the capital city of a mid-southern state known for a guy in a coonskin hat who was born on a mountaintop. I won’t say what kind of major surgery Helen had; you’ll find a clue in this sentence. Look again.


From Patient to Victim


Not only is my wife a good sport, she’s also a former EMT and EMD who’s not shy about critiquing healthcare—particularly her own. Helen agreed to let me trash her confidentiality so we could discuss how some of her in-patient experiences relate to prehospital practices.


Until the day of her operation, Helen was treated well by the medical-industrial complex. It wasn’t until she entered the hospital that The System, aware Helen now bore the mark of the unwell around her wrist, took steps to subordinate her by exploiting patients’ lowest common denominator: neediness. The more help she needed, the longer it took to get it. I’m not sure why; perhaps some of her caregivers saw their work as inherently confrontational. By enforcing pointlessly inflexible policy, they asserted control.


Want to speak with your attending physician—the one on a first-name basis with your intestines? Don’t call direct; if you do, your doctor’s receptionist will transfer you back to a floor nurse to take a message for—you guessed it—the attending physician.


Due for another shot of morphine in five minutes? Don’t even think about pressing the call button yet. I’d have more respect for such contrived precision if my wife wasn’t routinely kept waiting 20 minutes or more after her meds were due.


I’ve seen EMS providers’ rote adherence to procedures degenerate into us-against-them clashes with patients, too. I might have fostered some of those negative vibes when I thought I was merely enforcing treatment or transport policies.


Which am I promoting, safety or authority, if I automatically discourage bathroom breaks for patients before transport, or insist on a destination that works best for me, not them? The easier it gets to say no, the harder it is to remember why.


Most of the inpatient absurdities Helen endured were more annoying than dangerous, but some were scary. A few hours after waking up in recovery, Helen noticed part of her left thigh was numb. Her doctor said not to worry, then resumed rounds. A few days later, Helen suddenly developed edema in that leg. Her nurse said not to worry and started giving report to her relief. So what did Helen and I do? We worried, because numbness and edema so far from a surgical site aren’t normal. We needed someone with advanced medical training to halt the methodical processing of patients and focus on Helen’s complaints. We probably would have settled for the mere appearance of concern.


Making Time for Inconvenience


Lack of focus on the needs of the moment can be a problem prehospitally, too. Most of us have been seduced by calls that sound more interesting than the ones we’re on. Sometimes we have to remind ourselves that victims of “routine” illness or injury probably won’t appreciate whatever shortcuts we’re taking to chase “real” emergencies.


Is it possible to spend enough time with every patient? Probably not, but I can’t see setting an arbitrary limit of, say, 15 minutes, as the sign at one doctor’s office stated. Surely, face time should be dictated by something other than a ticking clock.


I realize fiscal realities intrude on almost all good intentions. However, after watching Helen struggle to be recognized as an individual, rather than as a transaction, I’m thinking medicine wasn’t meant to be a business. Sometimes it seems too difficult to care for people properly and profitably. Early physician-theologians had it right when they offered primitive healthcare as charitable acts instead of provider-centric indulgences. Wellness lags technology when patients are merely processed.


By the time Helen was subjected to the indignities of the infirm, I’d been away from EMS for a year. I’d taken my own turn as bed-bound pawn of the healthcare industry after several job-related injuries, and had plenty of time to consider what I’d do differently if I were still in the field. Most importantly, I’d want to oppose clinical apathy just as passionately as I did for my wife.


Someone has to stand up for the sick and injured. Who better than us?


Mike Rubin is a paramedic in Nashville, Tennessee and a member of EMS World’s editorial advisory board. Contact him at


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